Physician Credentialing Analyst

VITAS Healthcare•Miramar, FL

12d

About The Position

The Physician Credentialing Analyst supports the organization’s credentialing and re-credentialing compliance programs, with a focus on Medicaid and Medicare provider enrollments. The role provides analyses and reporting for organization-wide administration of the credentialing compliance function and evaluates compliance with internal policies and procedures and external vendor credentialing standards. The analyst must be able to attend meetings on-site at the Corporate Miramar, Florida office. The position collects physician-related documentation from programs to coordinate credentialing accurately and on schedule, conducts research and studies, prepares reports and presentations, and maintains an accurate computerized database. The analyst works with program management and staff, and confers with Risk Management and Legal as needed to help avoid potential compliance issues. The role also brings potential legal or risk-related concerns to internal management, provides guidance on documentation standards, and serves as a subject matter expert in credentialing compliance.

Requirements

Previous credentialing compliance experience.
Organizational, analytical, and problem-solving skills.
Personal computer skills and knowledge of Microsoft software.
Ability to maintain confidentiality and handle confidential information.
Detail orientation and good organizational skills.
Ability to work independently.
Ability to communicate professionally and courteously, verbally and in writing, with internal and external customers.
Ability to communicate tactfully with department heads, managers, coworkers, and vendors to resolve problems and negotiate resolutions.
Working knowledge of computers and internet access, and ability to navigate automated systems and software such as Outlook, Excel, and Word.
Ability to attend meetings on-site at the Corporate Miramar, Florida office.

Nice To Haves

Bachelor’s degree in Business Administration or a related field from an accredited college or university, or international equivalent; preferred.

Responsibilities

Support credentialing and re-credentialing compliance programs, particularly Medicaid and Medicare provider enrollments.
Analyze and report on organization-wide credentialing compliance and evaluate compliance with internal policies, procedures, and external vendor standards.
Collect physician-related documentation from programs to coordinate credentialing accurately and within defined schedules.
Conduct studies and research, perform data analysis, and prepare reports and presentations.
Develop standard and ad hoc reports, templates, dashboards, scorecards, and metrics.
Maintain an accurate and up-to-date computerized database.
Bring issues that could expose the organization to potential losses from adverse legal action or risk irregularities to internal management’s attention.
Confer with the Risk Management and Legal departments as needed to avoid potential compliance issues.
Meet with management to clarify project requests, highlight issues, and recommend ways to address issues and priorities.
Safeguard the integrity of the credentialing administration function through sound judgment and sharing best practices among programs.
Serve as a subject matter expert in credentialing compliance and confer with program management and staff.
Provide guidance to ensure documentation meets internal and external compliance standards.
Write detailed reports and deliver oral presentations to management.